TEXTO
DEMOCRACIES LINKED TO GREATER UNIVERSAL HEALTH COVERAGE COMPARED WITH AUTOCRACIES, EVEN IN AN ECONOMIC RECESSION
August 2021
Despite widespread recognition that universal health coverage is a political choice, the roles that a country’s
political system plays in ensuring essential health services and minimizing financial risk remain poorly
understood. Identifying the political determinants of universal health coverage is important for continued
progress, and understanding the roles of political systems is particularly valuable in a global economic
[5] recession, which tests the continued commitment of nations to protecting the health of its citizens and to
shielding them from financial risk.
Universal health coverage aims to ensure that all members of a population have access to the high-quality
essential health services that they need without suffering financial hardship. The importance of universal
health coverage to many countries and international institutions is emphasized by the fact that it is included
[10] in the UN Sustainable Development Goals. Yet, progress on achieving universal health coverage worldwide
was already uneven ahead of the 2030 Sustainable Development Goals deadline and may falter further
because of the COVID-19 pandemic and its associated economic downturn.
Estimates suggest that an additional 40.1 million people would have lost universal health coverage because
of the 2020 economic downturn if the world were composed of autocratic governments and if governments
[15] responded to recessions in 2020 as they did during the period 1990–2019. It is estimated that almost
35 percent of the world’s population resides in an autocratizing country, and autocratization has been
shown to be associated with slowed progress toward universal health coverage.
Democracies are more open to feedback from a broader range of interest groups, are more protective of
media freedom, and may be more willing to use that feedback to extend and improve effective essential
[20] health services. Autocracies, in contrast, reduce political competition and access to information, which might
deter constituent feedback and responsive governance. For similar reasons, autocracies may be more willing
than democracies to curb social spending during economic slowdowns, including investment in universal
health coverage. Democracies have a greater incentive to maintain or increase social spending, including
universal health coverage, to shore up electoral support during recessions.
Adapted from: healthaffairs.org. Accessed September 4 2023.
According to paragraph 1, the connection between political systems and universal health coverage is:
